Reckless use of antibiotics

The global threat of climate change and reckless use of antibiotics by the people across the world have much in common because both the things are going against the humanity. The World Antibiotic Week, a World Health Organisation campaign to focus attention on antibiotic resistance was observed close on the heels of the UN Climate Change Conference at Bonn in Germany last week. In both cases, the actions of people in one region have consequences across the globe because of better communication across the continents. Tackling both the serious issues requires collective action across multiple focus areas with the cooperation of the member countries in the larger interest of the people. For anti-biotic resistance, this means cutting the misuse and self-medication of antibiotics in humans and farm animals, fighting environmental pollution, improving infection control in hospitals and boosting surveillance. For having a positive impact on the people, most of these goals need government intervention, individuals also have a critical part to play. This is especially true for India, which faces a piquant situation when it comes to restricting the sale of antibiotics - some Indians use too few antibiotics, while others use too many. The reckless use of antibiotics is rampant among the people, who can afford to purchase medicines over the counters without any prescription from the doctors. Though some effort has been made by the governments in some of the states in the country yet this campaign is confined to papers only. This is because of the reason that laws and mechanisms have been formulated to restrict the sale of drugs over the counters but its implementation has been very poor. Most of the 410,000 Indian children, who die of pneumonia every year do not get the antibiotics they need, while others misuse drugs, buying them without prescription and taking them for viral illnesses like influenza. Sometimes this irrational use is driven by quacks in the field of medicine. But just as often, qualified doctors add to the problem by yielding to pressure from patients or drug-makers. This tussle - between increasing antibiotic use among those who really need them, and decreasing misuse among the irresponsible - has kept India from imposing blanket bans on the non-prescription sale of these drugs. When policymakers at the central government level proposed such a ban six years back, it was met with strong opposition from the druggists and chemists besides those in the profession of medicines. Instead, India turned to fine-edged tools such as the Schedule H1, a list of 24 critical antibiotics such as cephalosporins and carbapenems, whose sale is tightly controlled. But even Schedule H1 hasn't accomplished much: pharmacists often flout rules, and drug controllers at the state level are unable to monitor them. So in the process, the power to purchase antibiotics still remains in the hands of the consumers. Now, it is up to consumers now to appreciate the threat of antibiotic resistance and exercise this power with care. The miracle drugs form the backbone of modern medicines, and are needed for everything from prophylaxis for a complicated hip surgery to treatment for an infected knee scrape. Loss of these drugs would mean that even minor illnesses could become killers, and the cost of health care will soar disproportionately. Consumers need to remember and be aware that not all illnesses need antibiotics, and the decision and discretion on when to take them and for how long is best left to a medical professional. Multi-resistance in some tertiary-care hospitals to bugs has grown to dangerous levels across the globe. The problem in Indian hospitals is no different. But the experience of countries like Australia and other developed countries shows that cutting down on antibiotics can reverse such trends. The National Action Plan on Antimicrobial Resistance aims to repeat such successes in India. In the meantime, awareness has to be created among consumers so that they see the coming crisis and take up the baton. India has to formulate multi-pronged strategy to check misuse of antibiotics and make them available to those, who need the most. The formulation of such programmes also needs the cooperation of the common masses for making this a success in the years to come.